Healthcare Provider Details

I. General information

NPI: 1023939204
Provider Name (Legal Business Name): ZOE SUZANNE ALCORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 NOBLE DR
FORT WAYNE IN
46825-5544
US

IV. Provider business mailing address

1520 E BERRY ST APT 124
FORT WAYNE IN
46803-1001
US

V. Phone/Fax

Practice location:
  • Phone: 260-420-9332
  • Fax:
Mailing address:
  • Phone: 317-914-4254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: